Medical diagnosis, with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa.

Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis, with special reference to practical medicine : a guide to the knowledge and discrimination of diseases / by J.M. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    charge from the ear, or pain upon pressure over the mastoid process, or a chronic disease about the head, or an albumin- ous urine, or protracted suppuration in any part of the body, we may safely infer that an abscess, not a tumor, is the cause of the evident cerebral mischief. Chronic meningitis, an affection sometimes complicating tumor, is discriminated by laying stress on its etiologic rela- tions—such as blows upon the head, diseases of the bones, syphilis, rheumatism; and by observing its frequent yet irregular accessions of fever, the great irritability of temper, the dullness of intellect, the loss of memory, and the noc turnal delirium. The pain, too, is duller and more diffused than in tumor, and there is more vertigo; but the convul- sions, on the other hand, are less distinctly epileptiform in type. The precise seat of the tumor, it is impossible to determine. An affection of the special senses points to disease near to, or at the base of, the brain; and the probability of this view is much strengthened if there be paralysis of the face on the side opposite to that of the extremities, and if inspiration alone (by pressing the morbid mass against the walls of the cranium) cause or increase pain; whereas, so says the high authority of Romberg, in tumors on the upper surface, forced expiration produces a like result.* And what of their nature; can we form an opinion regard- * As regards the palsy of the face being on the side opposite to that of the body, this depends very much upon the exact position and extent of the lesion. If this affect the tuber annulare below the place of crossing of the fibres of the facial nerve, (which crossing has been proved by the physiological researches of Stilling and Phillipeaux,) it will cause paralysis of the face on one side, and of the limbs on the other. If the lesion involve a point above the crossing of the facial nerve fibres, the face and body are both palsied on the side opposite to the lesion. These points have been carefully studied, not only with reference to tumors, but to all forms of cerebral disease, by Gubler, De l'hemiplegie alterne envisag6e comme signe de lesion de la protuberance annulaire et comme preuve de la decussation des nerfs faciaux. Paris, 1856. The decussation of the facial nerves and the clinical facts mentioned by Gubler tend to explain the perplexing sub- ject alluded to when discussing hemiplegia, that the face is so often para- lyzed on the same side as the body.